Abstract
Coronary artery spasm (CAS) associated with catheter ablation is an important perioperative
complication. Here we describe a case of late-onset CAS with cardiogenic shock that
occurred five hours after ablation.
A 55-year-old man diagnosed with CAS previously underwent implantable cardioverter-defibrillator
(ICD) implantation due to ventricular fibrillation. Inappropriate defibrillation was
repeatedly conducted for frequent episodes of paroxysmal atrial fibrillation. Therefore,
pulmonary vein isolation and linear ablation, including cava-tricuspid isthmus line,
were performed. Five hours after the procedure, the patient experienced chest discomfort
and lost his consciousness. Electrocardiogram monitoring of lead II revealed atrioventricular
sequential pacing and ST-elevation. Cardiopulmonary resuscitation and inotropic support
were immediately started. Meanwhile, coronary angiography revealed diffuse narrowing
in the right coronary artery. Intracoronary infusion of nitroglycerin immediately
dilated the narrowed lesion; however, the patient required intensive care with percutaneous
cardiac pulmonary support and a left ventricular assist device. Pacing thresholds
obtained immediately after cardiogenic shock were stable and almost similar to previous
results. This showed that the myocardium was electrically responsive to ICD pacing
but was unable to contract effectively due to ischemia.
Learning objective
Coronary artery spasm (CAS) associated with catheter ablation commonly occurs during
ablation, but rarely as a late-onset complication. CAS may cause cardiogenic shock
despite proper pacing of the dual chamber. Continuous monitoring of the electrocardiogram
and arterial blood pressure is crucial for the early detection of late-onset CAS.
Continuous infusion of nitroglycerin and admission into the intensive care unit after
ablation may prevent fatal outcomes.
Keywords
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Article info
Publication history
Published online: February 21, 2023
Accepted:
January 13,
2023
Received in revised form:
December 13,
2022
Received:
July 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
